hi dr bob
great health and thanks for being for all of us here.had protected vaginal sex with a girl of unknown status and condom remained intact.no cuts and bruises on the penis.so the risk remains non exsistent.(thats what you tell all of us).but dr bob,the condom i bought was with nonoxyl-9 which i realised much afterand even the word latex was not written on the condom box but the chances are excellent that it was latex because i am here in malaysia and we are the biggest exporters of latex worldwide.
am i at any risk of hiv after using condom with nonoxyl-9.thanks for everything and expect a reply from you.really freaked and scared to death.careful in buying condoms in future.promise a donation by first week of next month.
love
martin

Response from Dr. Frascino

Hello Martin,

Relax! All is well including you. Assuming the latex condom was used properly and did not break, your HIV-transmission risk would be essentially nonexistent, whether or not the condom had nonoxynol-9 or not. The problem with nonoxynol-9 is that it can cause irritation to the mucous membranes it comes in contact with (your partner's vagina or rectum), thereby increasing the risk for HIV transmission. (The increased risk would not apply to you since you were not the one exposed and your tallywhacker was latex wrapped!)

I'll reprint some information below about nonoxynol-9 from the archives.

Stay safe. Stay well.

Dr. Bob

condom with Nonoxynol-9,i think im in trouble
Sep 12, 2006

Hi doc how are you, i hope you r very strong and healthy thank you for taking time to read my question, i could not find this question in archives ,i am a veteran in this web site, i read every question that you answer, 4 weeks ago i made sex with a girl i met in a bar ,i used condom , TROJAN-ENZ latex,but i never knew that it containes Nonoxynol-9, do you thing nonoxynol it's harmful to the latex,i checkt their web site and it says that TROJAN-ENZ CONTAINS 7% nonoxynol do you think i need to test after 3 months ,the condom was on from start till finish ,i used it just like it says in the package,i was not drunk ,thank you DOC and give STEVE a big hug for me,but carefull dont hurt him, tim, tx

Response from Dr. Frascino

Hi Tim,

Nonoxynol-9 (N-9) is not harmful to latex and will not harm the integrity of the condom. The problem with nonoxynol-9 is that it can irritate vaginal or rectal mucous membranes, thereby increasing the risk of HIV transmission if infected semen comes in contact with the inflamed membranes. See the posts from the archives below for additional information on N-9 and its HIV risk.

I hope you can answer my question. I recently had protected vaginal sex with a sex-worker in UK. We used a Condomi-'supersafe' condom, which I recently found out is lubricated with nonoxynol-9. I've read also that this can increase the risk of HIV transmission and now I'm getting really worried. Is this risk of infection increased for both partners? Can you help me doc? Also, I have noticed a blushing of red on my upper arms, and little red dots. Is this consistent with ARS, and does the rash come all at once, or develop over time?

Regretful in UK.

Response from Dr. Frascino

Hello,

If the condom did not fail (break), then you are not at risk for your sex-worker hokey-pokey hanky panky. However, we do recommend avoiding products that contain nonoxynol-9. I'll reprint some information below from the archives that addresses that topic.

Your "symptoms" are not consistent with ARS.

Stay safe. Stay well.

Dr. Bob

Nonoxynol-9 Harmful, Should Not Be Used in Condoms, Lube

By John S. James

June 28, 2002

On June 25, 2002 the World Health Organization published a 27-page report summarizing what is known about nonoxynol-9 (N-9) -- the failed microbicide that actually increases risk of HIV transmission. They concluded that N-9 should never be used for preventing HIV transmission, has no value in preventing other sexually transmitted diseases, and should never be used rectally, where the problem may be much worse than with vaginal use. (The report acknowledges that women at low risk of HIV infection may use N-9 occasionally as a moderately effective, female-controlled form of birth control, when better means are not available to them.)

Condoms should not include N-9 for any use. However, if the only condom available has N-9, it is better than no condom. On May 10, 2002 the U.S. Centers for Disease Control and Prevention updated its Guidelines for the Treatment of Sexually Transmitted Diseases (PDF), also warning against using N-9 for STD prevention.

Background and Comment

N-9 kills HIV in the laboratory. But it also causes irritation in the vagina or rectum that can allow HIV to infect. A major clinical trial in women, reported two years ago at the International AIDS Conference in Durban, South Africa, studied over 800 sex workers randomly given either an N-9 or placebo gel, and found 48% more new HIV infections among those using N-9.

No one has done such a study with rectal use. But in both humans and animals the irritation is worse, with "sloughing of sheets of epithelium." The damage is later repaired, but by then HIV could have been transmitted.

A recent survey found that about 40% of condoms sold in the U.S. are lubricated with N-9, and about 40% of gay men look for it. Manufacturers of condoms and lube have no incentive to include N-9, except for this mistaken public demand; and all of these manufacturers also market parallel versions of their products without N-9. Now that there is a clear, official consensus that N-9 is harmful, especially for rectal use, it is likely to start disappearing from condoms and lubes.

The community will need to help get the word out, since no one has a commercial incentive to do so, and government agencies are reluctant to speak about anal sex.

References

1. WHO/CONRAD Technical Consultation on Nonoxynol-9, World Health Organization, Geneva 9-10 October 2001, Summary Report. (This is the report published June 25, 2002; the October 2001 meeting brought together experts to examine the evidence and prepare recommendations.) As we go to press the report is available through www.who.int/reproductive-health/rtis/index.htm and also through: www.conrad.org.

2. "World Health Organization/Conrad Report Warns Against Use of Nonoxynol-9 As Microbicide," press statement issued June 25, available at the Web sites above.

Nonox-9 and "Non-Understanding" Jan 29, 2004

Dr. Bob,

Thanks for a terrific site and such a highly informative forum. I am a "questioning my orientation" male and have experienced insertive anal, and oral sex with me over the last year. I am OCD and hyper-sensitive about HIV, so condoms are used for insertive anal sex. And, up until recently, I thought that would protect me from HIV if used correctly (i.e. condom doesn't fall off, doesn't break). Well, until I read this article on THE BODY: http://www.thebody.com/kaiser/2004/jan21_04/nonoxynol_9.html Now I'm confused and nervous. In previous posts (and believe me I've checked them all pertaining to this!), you had stated HIV really can't "jump" over the latex barrier in condoms - thus providing effective protection. However, this article seems to suggest nonox-9 DOES transmit HIV somehow. Can you elaborate on this? Are we at risk for catching HIV when using a nonox-9 lubricated condom? How exactly does that risk materialize?

Also, unrelated to above, 2-weeks after having protected insertive anal sex with a guy - I experienced a 100.3-degree fever, sore throat, ear ache, stuffy face and nasea. These all lasted less than 24-hours. Two days before all this, I was playing contact football with a cousin who was just getting over the flu. I did have my flu shot in October. Regarding ARS, I know the "symptoms" sound right but would the duration be longer - or not necesisarily so? I'm a regular HIV tester, doing so 3-mons after each episode.

Thanks for your time.... 9

Response from Dr. Frascino

Hello,

You're welcome. I'm pleased you have found the information helpful. As for your being a "questioning my orientation" kind of guy, well from your post, I'd say that question's been answered! I do wonder about your statement, "I have experienced insertive anal and oral sex with me over the last year." Gosh, you must be very talented and remarkably flexible!

I haven't had the chance to review the article you reference, but let me give you the scoop on nonoxynol-9. It is true that the spermicide N-9 has been shown to increase the risk of HIV transmission, because it strips away the protective epithelial cells in the anus and vagina. However I think you may be confused about how this finding pertains --or does not pertain -- to your particular situation.

Ironically, N-9 was once touted as an HIV preventive, because initial tests showed it killed the virus. It was added to lubricants and condoms, and marketed as extra protection against HIV. However, subsequent tests involving human subjects showed that it had the opposite effect, because of its damage to the epithelial cells lining the anus and vagina. Please note these studies were done to see if N-9 would be an effective preventative barrier when condoms were not used or if condoms failed. Clearly that is not the case. If the lining of the anus or vagina is inflamed or damaged by N-9 and then comes into contact with HIV-infected ejaculate, HIV transmission becomes more likely. However, if there is no contact with infected ejaculate (condom remains intact), then HIV transmission still cannot occur. Since there is no upside for using N-9 and there is a definite downside, the product should not be used. Recently Durex, one of the top three condom makers, announced it would no longer make condoms lubricated with N-9. That leaves only the manufacturer of Lifestyles and Trojan brands making N-9 condoms. Pressure is being applied to these companies to discontinue N-9. We advise everyone to stop purchasing N-9 condoms and to ask their local pharmacies to remove the products from their shelves. Educating consumers and encouraging activism should speed the entire process along. Bottom line for your bottom since the condoms didn't fail, you should not be at any risk. But from here on "out" (so to speak), use only non-N-9 lubes and lubricated condoms. Buyer beware!

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